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Are We Ready to Give Up Control? Pressure Support Advisory System for Appropriate Unloading of Patient's Respiratory Muscles During Mechanical Ventilation in the Intensive Care Unit FREE TO VIEW

Ali Ataya, MD; Paul Stephan; Carl Tams; Michael Banner; Daniel Martin; Ibrahim Faruqi; Wael Nasser; Andrea Gabrielli; Hassan Alnuaimat
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University of Florida Health, Gainesville, FL

Chest. 2015;148(4_MeetingAbstracts):314A. doi:10.1378/chest.2241162
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SESSION TITLE: Mechanical Ventilation and Respiratory Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: VentAssist™ is an FDA approved neural network based pressure support advisory system that non-invasively estimates bedside work of breathing (WOBN/min). WOBN/min reflects the load on the inspiratory muscles to spontaneously inhale. The system is designed to provide recommendations for setting PS that maintain WOBN/min in appropriate range of 5-10 J/min, spontaneous breathing frequency (f) between 15-25 breaths/min, and tidal volume (VT) between 6-8 ml/kg. We hypothesized that by following these recommendations, patients could be weaned rapidly from PS while maintaining appropriate inspiratory muscle unloading.

METHODS: 21 adult patients admitted to the MICU with respiratory failure requiring invasive mechanical ventilation were enrolled at the University of Florida between January to December 2014. Patients were not being actively weaned by the treating team at the time of enrollement. Recommendations from VentAssist for setting PS were followed over 4-8 hours. The system provided recommendations to Increase, Decrease, or Maintain PS. Changes were made by increasing or decreasing PS by 2 cmH2O.

RESULTS: We observed that by following the PS recommendations, 18 of the 21 patients were weaned to minimum PS (5mmH20) in 46±30 mins. During this period the WOBN/min was maintained at 7±3J/min, f and VT were maintained in the aforementioned ranges. For the same period, PEEP was decreased from 8±2 cmH2O to 5 cmH2O and FIO2 was decreased to 0.40, while SpO2 was maintained >95% and partial pressure end-tidal CO2 ranged from 30-45mmHg.

CONCLUSIONS: By following real-time recommendations from a PS decision support system, ventilator settings were decreased rapidly to low levels, while inspiratory muscles were appropriately unloaded and oxygenation and ventilation were in acceptable ranges. At low ventilator settings, patients were considered to be candidates for extubation. The system may be a useful tool to allow quick weaning of PS and early liberation from mechanical ventilation in an ICU setting.

CLINICAL IMPLICATIONS: Based on these results, the open-loop VentAssist™ device may properly unload an intubated patient’s respiratory muscles and may be useful in expediting the patient’s weaning from PS in a short time. A clinical outcome study and future studies in a closed-loop device are needed.

DISCLOSURE: The following authors have nothing to disclose: Ali Ataya, Paul Stephan, Carl Tams, Michael Banner, Daniel Martin, Ibrahim Faruqi, Wael Nasser, Andrea Gabrielli, Hassan Alnuaimat

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